Rates of C difficile Risk Factors in Umbilical Cord Blood Transfer Patients

Confirmed risk factors for Clostridium difficile (C. difficile) include older age and antibiotic exposure, according to a new report.

Carolyn Alonso, MD, and researchers from Harvard Medical School examined 226 umbilical cord blood transplant patients to verify investigate local rates and risk factors for C. difficile infection in cord blood transplant recipients. Patients were recruited via electronic and paper records review from Beth Israel Deaconess Medical Center, Massachusetts General, and Brigham and Women’s Hospital between 2003 and 2012. The investigators gathered data about the patients’ white blood cell counts, serum creatinine, lactate, albumin, intensive care unit (ICU) admission (or lengthening of ICU stay) where C. difficile was a contributing factor, need for surgical intervention of colectomy, evidence of pseudomembranes, and death where C. difficile infection was a primary or contributing factor.

During the first 100 days of receiving a hematopoietic stem cell transplant, the researchers observed 4 types of gut decontamination regimens: 1) neomycin 1000 mg, polymyxin 500,000 units, nystatin 1.3 million units; 2) oral vancomycin 500 mg, oral tobramycin 250 mg, nystatin 1.3 million units; 3) neomycin sulfate 500 mg, polymyxin B sulfate 1 million units; and 4) polymyxin B sulfate 1 million units, bacitracin 100,000 units. The patients who received a decontamination regimen began the regimen at admission and continued until engraftment. They also received antibiotic prophylaxis with levofloxacin, the researchers determined. Two thirds of patients in the study received a gut decontamination regimen within the first 100 days of transplant.

“High risk” C. difficile infection antibiotics included anti-pseudomonal penicillins, fourth-generation cephalosporins, carbapenems, absorbable fluoroquinolones, and clindamycin, the study authors noted.

C. difficile infection was observed in 13.3% of the patients across the study period (30 participants) within the first year of transplant, the investigators found. The median time to infection was 38 days, they added, while no significant differences in rates of infection were noted among the institutions. Of interest, the average body mass index appeared higher in patients who developed C. difficile infection compared to those who did not (28.7 mg/m² vs 26.4 mg/m²).

Patients with leukemia accounted for most of the umbilical cord blood transplants (136) followed by patients with lymphoma (53). Nearly all transplants used double cord blood as the stem cell source, the study authors reported.

Patients who had umbilical cord blood transplants and developed C. difficile infection had a marginally longer duration of hospitalization compared with those without infection (46 vs 40 days, respectively), the researchers added. Metronidazole monotherapy was prescribed in half of the patients, with the remaining patients getting a combination of oral vancomycin monotherapy alone or in combination with intravenous or oral metronidazole.

“In our multivariable analysis, we found a link between bacterial infections during transplant and subsequent risk for C. difficile, which was independent of antibiotic use, and which was a novel finding,” Alonso told MD Magazine in an email. “To our surprise, there was no noted association between C. difficile and risk of death in the first 100 days of transplant.”

The study, titled, “A multicenter, retrospective, case-cohort study of the epidemiology and risk factors for Clostridium difficile infection among cord blood transplant recipients,” was published in the journal Transplant Infectious Disease.

RELATED COVERAGE

Increased Incidence of C difficile in Travelers Returning Home

Minimizing Clostridium difficile Exposure Using Disposable Commode Pails

Discovering the Risk Factors for Pediatric C difficile Infection